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General NPI Number Information
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NPI Number | 1720401052
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Entity Type | Individual
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Provider Name | KEITH HARTWELL
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Gender | Male
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 5969 VIZZI CT
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City | LAS VEGAS
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State | NV
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Zip | 89131-2858
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Country | US
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Telephone | 702-830-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 6512 N DECATUR BLVD STE 130-114
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City | LAS VEGAS
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State | NV
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Zip | 89131-1046
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Country | US
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Telephone | 702-830-2481
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Fax | 702-664-0648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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